Just hoping for opinions on my treatment

[Eugmn]

Hello, I haven’t posted much. I read all other post almost daily.

I have started to see changes in my PSA rising. .3 last May to currently 1.47. Just had new CT and bone scan that shows nothing changed for the pass 2 years. Dr wants to watch with new scans every 3 months. Chemo if we see changes. My history and treatments are in my bio.

Thanks

[Cooolone]

PSA rising indicates that the hormone sensitivity is waning? What's to wait for and see, I'm curious? Why wouldn't Docetaxel be considered now, early? Preventing Mets rather than allowing them to take root. Micro metastasis is the problem with advanced disease (PCa).

With the Prostate still there, you're still a low level, but approaching 2.0ng that is considered an action level by some. There are some benefits to chemo also as a reset to sensitivity for the hormone drugs which has been recently noted in some studies. Definitely a worthy conversation with your team. I'm sure there will be more knowledgeable and better responses.

Best Regards

[GP24]

If your PSA is rising slowly I do not see a reason to start with chemo at the first change in a bone scan. I would add SBRT radiation to the mets detected with the PSMA scan or get a new scan. While on ADT you can get a PSMA scan at very low PSA values, the PSMA expession of the cancer cells is just slightly lowered, not as much as the PSA value.

[Hidden]

I'm about the furthest thing from being a medical doctor as a person could get. However in the last six plus years of kicking metastatic prostate cancer around I have learned a few tidbits. Staring with bone & CT scans. They show only the obvious. They are also money makers for the cancer treatment centers. When they show cancer activity, it's after the fact. I read your profile, if I were in your shoes I would carpet bomb the cancer with Docetaxel. Why would I do it? Simply to prevent the cancerous cells from establishing a beachhead inside your body. It's there, don't let it run free based on the results of bone & CT scans. That being said, you will get opinions from our resident members who consider themselves "almost an oncologist." Best of luck to you!

[Tall_Allen]

Makes sense to add chemo. Alternatively, it sounds like you may qualify for the following BAT trial at UC.

clinicaltrials.gov/ct2/show...

They list this contact at Anschutz:

Michael D Wacker 720-848-3427 [e-mail]

[Eugmn in reply to Tall_Allen]

Thank you for the advice I truly appreciate it

[MateoBeach]

That transdermal BAT with enzalutamide trial looks like a good opportunity to see if that works for you. Docetaxel chemo as a backup. Good luck

[Eugmn]

Thank you for the advice I truly appreciate it

[SeosamhM]

Welcome, Eugmn! If you are currently on Zytiga and prednisone and there is no indication of met progression via scan, the very simplest next step is to ask your MO to investigate replacing prednisone with dexamethasone to see if you can squeeze some more time on Zytiga before chemo. Your PSA rise and scan experience mimics mine, and I responded favorably (so far, since 9/2020) to replacing pred with dex. But, if dex isn't for you, I agree with my inestimable peers here - ask your MO why earlier chemo isn't being considered.

And since you referenced us to your bio - just an ask to keep the dog posts in! It's nice to get away from numbers and just hear about a guy and his new(er) dog! Good luck! - Joe M.

[Eugmn in reply to SeosamhM]

Thanks for the advice. It will be discussed with my MO